Provider Demographics
NPI:1902140643
Name:THOMASON, SOPHIA RENEE
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:RENEE
Last Name:THOMASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 VALLEY DR
Mailing Address - Street 2:#1049
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3628
Mailing Address - Country:US
Mailing Address - Phone:702-343-7258
Mailing Address - Fax:
Practice Address - Street 1:5855 VALLEY DR
Practice Address - Street 2:#1049
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-3628
Practice Address - Country:US
Practice Address - Phone:702-343-7258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor